Validation of a hospital-acquired venous thrombosis risk assessment model: The medical inpatient thrombosis and hemostasis (MITH) study

Background: To reduce the risk of hospital-acquired venous thrombosis (HA-VTE) in medical patients, guidelines recommend assessing HA-VTE risk and providing prophylaxis for those at high risk. Risk assessment models (RAMS) including objective risk factors available at admission remain an unmet clinical need. Aim(s): To develop and validate a RAM for HA-VTE in medical inpatients using data available to providers within 24-h of hospital admission. Method(s): We developed a HA-VTE RAM at the University of Vermont Medical Center (Burlington, Vermont, USA, Table 1) and validated this RAM at Michigan Medicine (Ann Arbor, Michigan, USA, Table 2). HA-VTE and the risk factors were identified using previously validated computable phenotypes. The RAM was developed using a Bayesian LASSO approach with model performance assessed using area under the receiver operating curves (AUC) and the slope of observed versus expected plot. People admitted with VTE were excluded. The research was approved by the Institutional Review Board funded by the National Institutes of Health and the Centers for Disease Control and Prevention, USA. Result(s): Table 1 presents the risk factors, odds ratios (OR) and 95% credible intervals (CI) for the HA-VTE RAM, which included 11 risk factors. For the development cohort, based on 219 events among 62,468 admissions, the AUC of the model was 0.75 and the observed versus expected slope was 1.11 (Table 2). In the validation cohort there were 48,265 admissions and 363 HA-VTE events with a younger population and a higher incidence of HA-VTE. The AUC and the observed versus expected slope were 0.69 and 0.89 (Table 2). Conclusion(s): We developed and validated a HA-VTE RAM in populations. The model fit and calibration are promising especially given these are two geographically diverse institutions. Further validation is in progress at additional hospitals as well as in people hospitalized with COVID-19.

Evaluating resident involvement and the 'July effect' in parotidectomy.

OBJECTIVE: This study aimed to evaluate the effect of resident involvement and the 'July effect' on peri-operative complications after parotidectomy. METHOD: The American College of Surgeons National Surgical Quality Improvement Program database was queried for parotidectomy procedures with resident involvement between 2005 and 2014. RESULTS: There were 11 733 cases were identified, of which 932 involved resident participation (7.9 per cent). Resident involvement resulted in a significantly lower reoperation rate (adjusted odds ratio, 0.18; 95 per cent confidence interval, 0.05-0.73; p = 0.02) and readmission rate (adjusted odds ratios 0.30; 95 per cent confidence interval, 0.11-0.80; p = 0.02). However, resident involvement was associated with a mean 24 minutes longer adjusted operative time and 23.5 per cent longer adjusted total hospital length of stay (respective p < 0.01). No significant difference in surgical or medical complication rates or mortality was found when comparing cases among academic quarters. CONCLUSION: Resident participation is associated with significantly decreased reoperation and readmission rates as well as longer mean operative times and total length of stay. Resident transitions during July are not associated with increased risk of adverse peri-operative outcomes after parotidectomy.

Patient Perceptions and Satisfaction With Teledermatology During the COVID-19 Pandemic: A Survey-Based Study

BACKGROUND: The COVID-19 pandemic has drastically changed the practice of dermatology as social distancing guidelines have led to a shift from in-office care to virtual telehealth (teledermatology). We aimed to determine patient satisfaction, perceived barriers, as well as indications for teledermatology appointments during the COVID-19 pandemic. METHODS: A survey was sent out via SurveyMonkey's online platform to patients of the George Washington Medical Faculty Associates' Dermatology department who attended telehealth appointments during the COVID-19 pandemic. RESULTS: Out of 894 invitations sent, 168 patients completed our survey.The most common reasons for making a telehealth appointment were for a new rash (11.6%), eczema (9.8%), and psoriasis (9.1%). The most common reasons respondents liked telehealth were because of time efficiency (81.1%), not requiring transportation (74.2%), and maintaining social distancing (73.6%). The most common reasons respondents did not like telehealth were due to lack of physical touch (26.8%) and feeling they received an inadequate assessment (15.7%). Very few patients reported that they were unlikely to undertake another telehealth visit (9.94%) or recommend a telehealth visit to others (6.92%). CONCLUSION: Dermatology patients likely perceive telehealth visits as a convenient and safe method for quality care during the COVID-19 pandemic. The lack of physical touch, inability to provide close inspection and/or procedural intervention can be frustrating for patients and therefore meaningful selection of appropriate cases for telehealth visits can optimize the patient experience. Overall, telemedicine represents an effective and safe vehicle for delivering care especially during a global pandemic. J Drugs Dermatol. 2021;20(2):178-183. doi:10.36849/JDD.2021.5714.